Tag Archives: follow-up studies of transition

Long-term follow-up of individuals undergoing sex reassignment surgery: Psychiatric morbidity and mortality – Review of Abstract

The authors of the study suggest that gender reassignment surgery may increase psychiatric problems for some people and decrease them for other people.

The study looked at the medical records of 104 people who had sex reassignment surgery in Denmark between 1978 and 2000.

They found that there was no statistically significant difference between the number of psychiatric diagnoses before surgery and after surgery.

In addition, the people who had diagnoses before surgery were different from the people who had diagnoses after surgery. Only 6.7% of the group had a psychiatric diagnosis both before and after surgery while 27.9% of the group had a psychiatric diagnosis before surgery and 22.1% had one afterwards.

According to the authors “this suggests that generally SRS may reduce psychological morbidity for some individuals while increasing it for others.”

The study also found that:

Psychiatric diagnoses were over-represented both before and after surgery (i.e. the group had more psychiatric issues than the general population).

Trans men (born female) had a significantly higher number of psychiatric diagnoses overall; there were no other statistically significant differences between trans men and trans women.

At the same time “significantly more psychiatric diagnoses were found before SRS for those assigned as female at birth.”

10 people had died at an average age of 53.5 years.

Questions for the Future

The most important question is, of course, how can we make sure that SRS does not increase psychiatric problems in the future?

Is it a question of better screening to identify gender dysphoria?

Do people need more support and counseling after surgery?

Should some people transition without getting surgery?

Were poor surgical outcomes linked to psychiatric problems?

Could low hormone levels after surgery cause problems for some people?

Were people’s problems caused by the surgery or some other aspect of transition that happened after surgery?

Or to put it another way, how do we identify which people might benefit from surgery and which might be hurt by it? or do we need to make other changes to prevent new psychiatric diagnoses after surgery?

It would also be helpful to know more about the specific psychiatric diagnoses before and after surgery. Are we seeing increases in depression, anxiety, eating disorders, or what?

How did the patients whose mental health improved compare to those whose mental health got worse? Were they older or younger? What were their life circumstances?

What does it mean that trans men had more psychiatric diagnoses before surgery? Was surgery more beneficial for them than for trans women or did trans men just have more psychiatric problems overall?

How long after surgery did people get the new psychiatric diagnoses?

More about the study:

Only the abstract of the study is available online, so it is hard to interpret some of their results.

The abstract gives few further details on their methodology, but a similar study of physical illnesses and death looked at the records of 56 trans women (born male) and 48 trans men (born female). The follow-up period began when people received permission for surgery. The group used in the other study represented 98% of all people who officially had SRS in Denmark from 1978 to 2000.

Original source:

Long-term follow-up of individuals undergoing sex reassignment surgery: Psychiatric morbidity and mortality by Simonsen RK, Giraldi A, Kristensen E, Hald GM in Nord J Psychiatry. 2016;70(4):241-7.

Suicide is not a Footnote

I am fed up with studies that treat suicide like a footnote.

You are not talking about “patients” or “participants” or “transsexuals.” You are talking about people.

If someone commits suicide during the study, I want to read about it in the abstract, not buried in the methods section. So somebody died and didn’t participate in your study – that is not the important story.

Why did they commit suicide? When did they commit suicide – before or after medical treatment? What medical and therapeutic treatments were they getting? Were there any underlying mental health issues that weren’t being treated? Did they need more support during and after transition? Were they properly diagnosed? Did they have depression? Were they trauma survivors?

You don’t get to ignore their death in your conclusions. The person’s death is part of your results. Suicide needs to be reported in your results and it needs to be discussed.

Most of all, you need to talk about what we can do to reduce the number of suicides and suicide attempts among transgender people.

 

To my readers, if you or someone you love is thinking about suicide:

Sources of Help and Information:

Trans Lifeline for trans people:

  • US number: 1-877-565-8860
  • Canadian number: 1-877-330-6366
  • and their website.

The Trevor Lifeline for LGBTQ youth (US) – 1-866-488-7386 and their website.

National Suicide Prevention Lifeline (US): 1-800-273-TALK (8255) and their website.

The International Association for Suicide Prevention – their website has an interactive map with phone numbers and locations of crisis centers.

What to Do

If someone you know exhibits warning signs of suicide:

  • Do not leave the person alone
  • Remove any firearms, alcohol, drugs or sharp objects that could be used in a suicide attempt
  • Call the U.S. National Suicide Prevention Lifeline at 800-273-TALK (8255)
  • Take the person to an emergency room or seek help from a medical or mental health professional

Two Years After My Suicide Attempt, I’m Still Living and Sharing

“Waking up two years ago gave me opportunities, some of which seem obvious but some of which I’m still discovering. I have the opportunity to continue the life I began and do the things I want to do. I have the opportunity to offer help to people who would have helped me if only I had shared what was going on.”

Read more here.

From Maria Shriver’s blog, Powered by Inspiration.